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Persistence of atopic dermatitis (AD): A systematic review and meta-analysis

Published:August 18, 2016DOI:https://doi.org/10.1016/j.jaad.2016.05.028

      Background

      Previous studies found conflicting results about whether childhood atopic dermatitis (AD) persists into adulthood.

      Objective

      We sought to determine persistence rates and clinical factors associated with prolonged AD.

      Methods

      A systematic review was performed in MEDLINE, EMBASE, Scopus, GREAT, LILACS, Web of Science, Academic Search Complete, and Cochrane Library. Meta-analysis was performed using Kaplan-Meier plots and random-effects proportional hazards regression.

      Results

      In total, 45 studies including 110,651 subjects spanning 434,992 patient-years from 15 countries were included. In pooled analysis, 80% of childhood AD did not persist by 8 years and less than 5% persisted by 20 years after diagnosis (mean ± SE: 6.1 ± 0.02 years). Children with AD that persisted already for more than 10 years (8.3 ± 0.08 years) had longer persistence than those with 3 (3.2 ± 0.02 years) or 5 (6.8 ± 0.06 years) years of persistence. Children who developed AD by age 2 years had less persistent disease (P < .0001). Persistence was greater in studies using patient-/caregiver-assessed versus physician-assessed outcomes, female versus male patients (P ≤ .0006), but not in those with sensitivity to allergens (P = .90). Three studies found prolonged persistence with more severe AD.

      Limitations

      Some studies did not capture recurrences later in life.

      Conclusions

      Most childhood AD remitted by adulthood. However, children with already persistent disease, later onset, and/or more severe disease have increased persistence.

      Key words

      Abbreviations used:

      AD (atopic dermatitis), CI (confidence interval), HR (hazard ratio)
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      Linked Article

      • Conclusions about atopic dermatitis persistence might be premature
        Journal of the American Academy of DermatologyVol. 76Issue 5
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          To the Editor: We read the review by Kim et al1 and applaud the authors for addressing this important challenging topic. It is well known that atopic dermatitis (AD) is a condition whereby patients often have episodic flares and that some patients might have prolonged periods without symptoms followed by recurrences.2 The relapsing nature of AD complicates the measurement of disease activity over time and the average frequency and duration of asymptomatic periods is variable and poorly defined. For these reasons, the definition of persistence is not straightforward, and a meta-analysis on this topic requires careful consideration of methodologic issues and clear explanations of terminology.
        • Full-Text
        • PDF
      • Heterogeneity of data included in meta-analysis on persistence of atopic dermatitis changes interpretation
        Journal of the American Academy of DermatologyVol. 76Issue 5
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          To the Editor: We enjoyed reading Persistence of atopic dermatitis (AD): A systematic review and meta-analysis but have concerns.1,2 The goal of this publication was to determine if childhood AD persists through life.2 The study combined data from about 44 studies. The term pooled is used in this publication, which usually refers to the pooling of individual level data; however, the analysis appears to pool study data.2,3 We feel strongly that the results of this study should be interpreted with caution.
        • Full-Text
        • PDF